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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �?�0 � — p i n2 S"�� �e�tF, l.�A �r9aol <br /> PROJECT ADDRESS <br /> ,�'Qv��(, C9eavu a�o� p��ne s+ye�I- �,vevet�, W�- 9 s�o i �1 as- �so• .�a s� <br /> Owner Mail Address Cily Stale2ip Phone <br /> �e.vr�� LUnn (_c�fa�c( ��loy Pir�e St�. �w�2v2�'j (AJR- �8 a01 9�5• aSa-SSSL, <br /> Tenanl Mail Address City SWte/Zip Phone <br /> b�t dutn.e,� <br /> Eleclrical Contrac�r Mail Address City � Slate/Zip Phone <br /> Stale License Number Contract Price of Work <br /> 5-tvraq e <br /> Proposed Use of B ding Conlacl Person (Plan Review) <br /> Descriplion oF Work to 8e Done: lr2.C.0Y1 V12C�1 l'lG y' � l'JV'e0.k-e V P.�P�,'f Y1CQ,L nQVL2L <br /> Cl v�. �kln Vt i kCt o� y J u� w i Y'e, � s r�Vcw -f=c)a m fi v2 1� (oe4c:�v�a <br /> \ NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certily(haf 1 have read and caamined this applicafion and know fhe same!o be true and � �hdC1- ��'3 <br /> correct. All pwvis��ns o/la�rs and ordinances govemm�this type ol wo�k will be completed <br /> �vhether speciGed herein or not The�ranting ol a perrnrt does not presume fo give authonty fo <br /> violafe or cance� fhe provisions of any oUier slate or/ocal law regulafing consfn�clion or the <br /> pe�fornrance ol conshucfiai. That 1 arn authonzed by the ouvier o/fhis properly to perform Uie <br /> �vork lor�vhich applicatiun is made and I comply�vi(h the Stafe Confractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> !� O / /o <br /> Signatur j� � Date <br /> r' <br />